甲狀腺乳頭狀癌頸部淋巴結(jié)轉(zhuǎn)移影像學(xué)特征與病理結(jié)果對比分析
發(fā)布時間：2018-08-16 08:59
【摘要】：目的：甲狀腺乳頭狀癌是甲狀腺惡性腫瘤中最為常見的類型，約占的甲狀腺癌的80%，具有較高淋巴結(jié)轉(zhuǎn)移率。而淋巴結(jié)轉(zhuǎn)移又是影響預(yù)后的重要因素之一，故術(shù)前對甲狀腺癌患者頸部淋巴結(jié)的準確評估至關(guān)重要。甲狀腺乳頭狀癌的轉(zhuǎn)移淋巴結(jié)有一定的影像學(xué)特征，了解其影像表現(xiàn)，對提高診斷的準確率具有重要意義。本研究旨在探討影像學(xué)檢查對甲狀腺乳頭狀癌頸部淋巴結(jié)轉(zhuǎn)移的診斷價值。 方法：回顧性分析河北醫(yī)科大學(xué)第四醫(yī)院耳鼻咽喉-頭頸外科自2013年3月～2013年10月間79例患者的臨床資料，其中66例為初次手術(shù)，13例為二次術(shù)后。79例患者中，有36例(38側(cè))頸部觸診及影像學(xué)檢查均為陽性；37例(44側(cè))頸部觸診陰性，影像學(xué)檢查為陽性；6例頸部觸診及影像學(xué)檢查均為陰性，術(shù)后經(jīng)病理證實有轉(zhuǎn)移性淋巴結(jié)。本組資料術(shù)前均常規(guī)行超聲學(xué)檢查，24例同時行頸部平掃增強CT檢查。根據(jù)甲狀腺原發(fā)灶、頸部淋巴結(jié)術(shù)中快速冰凍病理結(jié)果，依據(jù)中國甲狀腺結(jié)節(jié)和分化型甲狀腺癌診治指南中甲狀腺切除及頸清掃適應(yīng)癥行相應(yīng)術(shù)式，術(shù)后標本均送檢病理，將術(shù)前影像學(xué)檢查與術(shù)后病理結(jié)果進行回顧性對比分析。 結(jié)果： 1轉(zhuǎn)移性淋巴結(jié)的長徑/短徑(L/S)敏感度為82.2%、特異度為57.1%，準確率為74.2%；淋巴門結(jié)構(gòu)消失敏感度為85.4%、特異度為72.2%，準確率為81.8%；淋巴結(jié)內(nèi)出現(xiàn)點狀鈣化敏感度為91.6%、特異度為56.6%，準確率為75.7%；囊性變敏感度為92.8%、特異度為36.5%，準確率為48.4%。經(jīng)χ2檢驗甲狀腺乳頭狀癌頸部淋巴結(jié)轉(zhuǎn)移組和非轉(zhuǎn)移組之間上述聲像學(xué)特征的差異均具有統(tǒng)計學(xué)意義(P＜0.05)。 以具備L/S＜2、淋巴結(jié)內(nèi)出現(xiàn)點狀鈣化、淋巴門結(jié)構(gòu)消失、囊性變中兩條及兩條以上聲像學(xué)特征作為可疑淋巴結(jié)轉(zhuǎn)移的指標進行綜合考慮，超聲診斷甲狀腺癌頸部淋巴結(jié)轉(zhuǎn)移的敏感度為92.1%、特異度為60.7%、準確率為78.7%。上述指標均高于以單一聲像學(xué)特征的診斷指標。 2術(shù)前經(jīng)超聲檢查且術(shù)后經(jīng)病理證實的初次手術(shù)患者轉(zhuǎn)移性淋巴結(jié)在頸部各區(qū)域的分布為:Ⅱ區(qū)(50.9%)、Ⅲ區(qū)(71.7%)、Ⅳ區(qū)(67.9%)、Ⅴ(30.2%)、Ⅵ區(qū)(45.3%)。 3超聲診斷甲狀腺癌術(shù)后頸部淋巴結(jié)復(fù)發(fā)轉(zhuǎn)移的二維聲像學(xué)各特征的敏感度、特異度及準確率均低于初次手術(shù)患者。 424例同時行頸部平掃增強CT檢查的患者中，，21例術(shù)后病理結(jié)果為轉(zhuǎn)移性淋巴結(jié)，CT在診斷甲狀腺乳頭狀癌頸部淋巴結(jié)轉(zhuǎn)移的敏感度、特異度及準確率分別為100%、50%、87.5%。其影像學(xué)特征包括：細顆粒狀、斑塊狀鈣化；囊變壞死區(qū)；增強掃描時淋巴結(jié)邊緣明顯強化；與周圍組織分界不清；氣管食管溝淋巴結(jié)直徑＞5mm。 結(jié)論： 1超聲對甲狀腺乳頭狀癌頸部淋巴結(jié)轉(zhuǎn)移的診斷有其特征性聲像學(xué)表現(xiàn)：L/S＜2、淋巴門結(jié)構(gòu)消失、點狀鈣化、囊性變,將上述多個特征綜合分析，有助于提高診斷的準確率，對臨床治療決策的制定具有重要意義。 2超聲對甲狀腺癌術(shù)后頸部腫大淋巴結(jié)的診斷和鑒別診斷也具有重要價值，是甲狀腺癌術(shù)后隨訪過程中重要的監(jiān)測手段之一，對具有上述聲像學(xué)特征的可疑淋巴結(jié)可行細針穿刺細胞學(xué)檢查。 3CT檢查影像學(xué)特征包括：細顆粒狀、斑塊狀鈣化；囊變壞死區(qū)；增強掃描時淋巴結(jié)邊緣明顯強化；與周圍組織分界不清；氣管食管溝淋巴結(jié)直徑＞5mm。對確定甲狀腺乳頭狀癌頸部淋巴結(jié)轉(zhuǎn)移具有重要的意義，可以提高淋巴結(jié)轉(zhuǎn)移診斷的敏感度，并精確定位，應(yīng)列為常規(guī)檢查。 4超聲和CT檢查聯(lián)合檢查，互為補充更有利于指導(dǎo)臨床。
[Abstract]:Objective: Papillary thyroid carcinoma is the most common type of thyroid malignancy, accounting for about 80% of thyroid cancer, with a high rate of lymph node metastasis. Lymph node metastasis is one of the important factors affecting prognosis, so it is very important to accurately evaluate the cervical lymph nodes of thyroid cancer patients before operation. Lymph nodes have certain imaging features, and understanding their imaging manifestations is of great significance to improve the accuracy of diagnosis.
Methods: The clinical data of 79 cases of Otolaryngology Head and neck surgery in the Fourth Hospital of Hebei Medical University from March 2013 to October 2013 were retrospectively analyzed. 66 cases were primary operation and 13 cases were secondary operation. Of the 79 cases, 36 cases (38 sides) were positive in cervical palpation and imaging examination, 37 cases (44 sides) were negative in cervical palpation and imaging examination. Ultrasound examination was routinely performed before operation and enhanced CT examination was performed in 24 cases simultaneously. According to the pathological results of primary thyroid lesions, cervical lymph nodes were frozen rapidly during operation. The indications of thyroidectomy and neck dissection in the diagnostic and therapeutic guidelines for differentiated thyroid carcinoma were analyzed retrospectively.
Result:
The sensitivity, specificity and accuracy of lymph node metastasis were 82.2%, 57.1% and 74.2%, 85.4%, 72.2% and 81.8%, 91.6%, 56.6% and 75.7% respectively, and 92.8% and 3.8% respectively. _2 test showed that there were significant differences between the cervical lymph node metastasis group and non-metastasis group (P < 0.05).
The sensitivity, specificity and accuracy of ultrasonic diagnosis of cervical lymph node metastasis of thyroid carcinoma were 92.1%, 60.7% and 78.7% respectively. Diagnostic criteria for single sonographic features.
2 The distribution of metastatic lymph nodes in the cervical region of the patients with primary operation confirmed by ultrasonography before operation and pathology after operation were: region II (50.9%), region III (71.7%), region IV (67.9%), region V (30.2%) and region VI (45.3%).
The sensitivity, specificity and accuracy of two-dimensional ultrasonography in the diagnosis of cervical lymph node recurrence and metastasis after thyroidectomy were lower than those of primary operation.
Of the 424 patients who underwent cervical plain and enhanced CT, 21 had metastatic lymph nodes. The sensitivity, specificity and accuracy of CT in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma were 100%, 50% and 87.5%, respectively. The margin of lymph nodes was significantly enhanced, and the surrounding tissues were not clearly defined. The diameter of tracheoesophageal groove lymph nodes was more than 5mm..
Conclusion:
1. Ultrasound has its characteristic sonographic features in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma: L/S<2, the disappearance of lymphatic hilar structure, punctate calcification and cystic degeneration.
Ultrasonography is also of great value in the diagnosis and differential diagnosis of cervical enlarged lymph nodes after thyroidectomy. It is one of the important monitoring methods in the follow-up of thyroid cancer. Fine needle aspiration cytology is feasible for suspicious lymph nodes with the above sonographic characteristics.
The imaging features of 3CT include fine granular, plaque calcification, cystic degeneration and necrosis, marked enhancement of lymph node margin, unclear demarcation with surrounding tissues, and the diameter of tracheoesophageal groove lymph nodes > 5mm. It is of great significance for cervical lymph node metastasis of papillary thyroid carcinoma and can improve the diagnosis of lymph node metastasis. The sensitivity and accuracy of breakage should be classified as routine examination.
4 joint examination of ultrasound and CT examination is complementary to each other, which is more conducive to guiding clinical practice.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R736.1;R445.1
本文編號：2185515
[Abstract]:Objective: Papillary thyroid carcinoma is the most common type of thyroid malignancy, accounting for about 80% of thyroid cancer, with a high rate of lymph node metastasis. Lymph node metastasis is one of the important factors affecting prognosis, so it is very important to accurately evaluate the cervical lymph nodes of thyroid cancer patients before operation. Lymph nodes have certain imaging features, and understanding their imaging manifestations is of great significance to improve the accuracy of diagnosis.
Methods: The clinical data of 79 cases of Otolaryngology Head and neck surgery in the Fourth Hospital of Hebei Medical University from March 2013 to October 2013 were retrospectively analyzed. 66 cases were primary operation and 13 cases were secondary operation. Of the 79 cases, 36 cases (38 sides) were positive in cervical palpation and imaging examination, 37 cases (44 sides) were negative in cervical palpation and imaging examination. Ultrasound examination was routinely performed before operation and enhanced CT examination was performed in 24 cases simultaneously. According to the pathological results of primary thyroid lesions, cervical lymph nodes were frozen rapidly during operation. The indications of thyroidectomy and neck dissection in the diagnostic and therapeutic guidelines for differentiated thyroid carcinoma were analyzed retrospectively.
Result:
The sensitivity, specificity and accuracy of lymph node metastasis were 82.2%, 57.1% and 74.2%, 85.4%, 72.2% and 81.8%, 91.6%, 56.6% and 75.7% respectively, and 92.8% and 3.8% respectively. _2 test showed that there were significant differences between the cervical lymph node metastasis group and non-metastasis group (P < 0.05).
The sensitivity, specificity and accuracy of ultrasonic diagnosis of cervical lymph node metastasis of thyroid carcinoma were 92.1%, 60.7% and 78.7% respectively. Diagnostic criteria for single sonographic features.
2 The distribution of metastatic lymph nodes in the cervical region of the patients with primary operation confirmed by ultrasonography before operation and pathology after operation were: region II (50.9%), region III (71.7%), region IV (67.9%), region V (30.2%) and region VI (45.3%).
The sensitivity, specificity and accuracy of two-dimensional ultrasonography in the diagnosis of cervical lymph node recurrence and metastasis after thyroidectomy were lower than those of primary operation.
Of the 424 patients who underwent cervical plain and enhanced CT, 21 had metastatic lymph nodes. The sensitivity, specificity and accuracy of CT in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma were 100%, 50% and 87.5%, respectively. The margin of lymph nodes was significantly enhanced, and the surrounding tissues were not clearly defined. The diameter of tracheoesophageal groove lymph nodes was more than 5mm..
Conclusion:
1. Ultrasound has its characteristic sonographic features in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma: L/S<2, the disappearance of lymphatic hilar structure, punctate calcification and cystic degeneration.
Ultrasonography is also of great value in the diagnosis and differential diagnosis of cervical enlarged lymph nodes after thyroidectomy. It is one of the important monitoring methods in the follow-up of thyroid cancer. Fine needle aspiration cytology is feasible for suspicious lymph nodes with the above sonographic characteristics.
The imaging features of 3CT include fine granular, plaque calcification, cystic degeneration and necrosis, marked enhancement of lymph node margin, unclear demarcation with surrounding tissues, and the diameter of tracheoesophageal groove lymph nodes > 5mm. It is of great significance for cervical lymph node metastasis of papillary thyroid carcinoma and can improve the diagnosis of lymph node metastasis. The sensitivity and accuracy of breakage should be classified as routine examination.
4 joint examination of ultrasound and CT examination is complementary to each other, which is more conducive to guiding clinical practice.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R736.1;R445.1
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